Case management for people with psychiatric disabilities in rural Sweden; experiences from the implementation of a national policy

The aim is to analyse the implementation of a case manager-model in rural Sweden. A sample of 15 case management teams was selected. Written materials were collected and interviews on location were carried out. Results: rural case managers design their work methods themselves, which entail several deviations from the national policy guidelines in this field. The case management boards have a low capacity to direct and manage the activities of the case managers. Consequently, case managers develop into ‘welfare entrepreneurs’. One salient risk is that teams become isolated from the surrounding welfare system. In conclusion, the Swedish version of case management in rural areas is a result of local processes of adaptation and negotiation that result in services that differ from those envisaged in national policy guidelines.